First Ethical Dilemma…
07/29/2019
I faced my first ethical dilemma on Day 12. In the middle of my shift, my supervisor Claire called me with a patient referral from a nurse. Usually, Claire gives me a list of patient referrals from nurses and other CARE volunteers before I start my shift. From there I work from my list as well as ask nurses on the units if they have any recommendations. This is the first time Claire gave me a patient referral in the middle of my shift, so I suspected that this was serious. Claire informed me that this patient was feeling lonely and would benefit from company. My shift started on the slow today, so I was glad to come to this patient’s rescue. Upon arrival and after a brief conversation with her, I learned that this patient – I’ll call her Ms. RT – was a retired nurse’s assistant with a passion for shopping. She was close to her five older siblings and their families and enjoyed spending money on clothes and fancy food. The reason why she was feeling so lonely today was because her family lived far away and could not visit her. She also lives in an assisted living home, so I suspect that whatever friends she has are unable to visit her as well. I can tell that my arrival made Ms. RT’s day, because as soon as I offered to keep her company, her face lit up. Our initial interaction was brief, because, after about ten minutes of chatting, her nurse and PCA (patient care associate) had me step out because they needed to wash and change Ms. RT.
Ms. RT was on my mind from the time I left her to when I returned to her about a half an hour later. Since we talked so much during our first interaction and she did not have kids or pets, she blew through my preliminary questions quickly. I was not sure what else I could ask her to spark a conversation that would cheer her up. I was also nervous about accidentally stumbling into sensitive territory and possibly making her more upset. I ended up confiding in my other supervisor, Carley, for advice. In sum, she assured me that I was on the right track with the types of questions I asked and encouraged me to use the intervention tools to supplement our conversation. Re-inspired and determined, I continued with my shift until Ms. RT was free again.
My second interaction with Ms. RT was lengthy but pleasant. When I returned, she immediately requested the coloring I offered when we first met. I helped her choose a coloring sheet and handed her color pencils whenever she needed them. She seemed to enjoy herself as she colored and she chatted on about her previous profession, life in her nursing home, and memories of her family. Whenever she became a bit emotional from a memory, I redirected the conversation to keep the mood positive. All and all, it was a great interaction that we both enjoyed.
Unbeknownst to Ms. RT, my ethical dilemma regarding her began in the middle of our conversation. While answering one of my questions, Ms. RT suddenly stopped and made a face. At first, I didn’t think too much of it, since Ms. RT showed strange mannerisms while we talked such as crying out whenever she tried to remember something. However, I had to hide my surprise when Ms. RT announced that she urinated on herself. She explained that her doctor had her take a water pill for a test, and, since she was bed-ridden state and medical condition, she could only urinate on herself without warning. I honestly did not expect her to tell me all this. Once she did, I encouraged her to use her nurse call button to have her nurse or PCA come in to change her. I reasoned that she should not have to sit in her urine, especially since it was probably uncomfortable. She politely declined, explaining that she didn’t want to bother the staff since they just cleaned her. I urged her to call anyway because it’s the staff’s job to take care of her. However, she insisted on leaving it alone since she worried that, if she called them too many times, they would not come if she called for an emergency. I decided to give it a rest since her situation did not seem to bother her. She arbitrarily reminded me that she soiled herself throughout the rest of our meeting. Each time I would urge her to call her nurse to take care of it and each time she explained that she did not want to, in her words, be any more of a burden than she already is. I respected her wishes with a grain of salt. It was difficult for me to talk to her knowing that she was sitting in her urine and help was a button away. I also worried her situation could not only lead to further discomfort but also additional medical problems such as bed sores. Sitting with these thoughts flooding my mind made this a visit to remember!
Decision time came when I said my goodbyes to Ms. RT and saw her nurse on my way out. Should I tell her nurse? I was not sure if it would be my place. I knew Ms. RT was paranoid about telling someone right away so, me telling her nurse may have made things worse. I also did not know if I was legally allowed to. In retrospect, I don’t think me telling staff members about Ms. RT being wet would be considered PHI* because it was not confidential information…I think. Still, at the time I believed this was a genuine concern and did not want to be sued for helping a patient. I decided to not say anything, but it was more difficult for me to stay quiet when I saw Ms. RT’s nurse in the hallway a few minutes later. She was walking and looked perfectly free to help Ms. RT – all I had to do was speak up. I ultimately decided against it since the PHI threat scared me too much. At the end of my shift, I told Claire about my predicament and she made a note to call the nurse about it immediately. Like me, she agreed that Ms. RT should not sit in her urine because of the potential medical problems. She also informed me that it would have been okay for me to tell Ms. RT’s nurse about her situation in private and I did the right thing by asking before acting. The next day, Claire told me that Ms. RT was doing well, and she had two other volunteers visit her after me. I’m glad everything worked out for the better and that my first scrape with ethical choices was smooth but challenging.
PHI – “PHI stands for Protected Health Information. The HIPAA Privacy Rule provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes.”
Source: https://www.hhs.gov/answers/hipaa/what-is-phi/index.html